Medical Case Management Program Leads To Lower Health Care Costs
A study released by health insurer Aetna found the cost of providing medical care for health plan members suffering from serious health problems is significantly lower when patients are enrolled in a case management program.
For the purposes of the study, Aetna researchers compared data from members enrolled in its Medical/Psychiatric High Risk Case Management Program (Med/Psych)—which targets members who have both chronic medical conditions and mental health problems, such as diabetes and depression—with data from members with at least one serious health condition who were not enrolled in a case management program. The study looked at the medical, pharmacy, and utilization costs incurred by members of both groups over the course of a one year period.
Results of the evaluation showed that, on average, participation in the Med/Psych program led to a cost savingsof $136 per member, per month. A breakdown of the costs indicated that, while pharmacy costs were $39 higher and antidepressant costs were $11 higher for members enrolled in the program than for non-enrollees, medical costs for Med/Psych participants were $175 lower than for non-participants.
In addition, a questionnaire measuring symptoms, functioning, and quality of life showed that program participants experienced improvements in their own perceptions of their physical and mental health after enrolling in the program. The questionnaire also found that program participants had been at work an average of three days more per month after enrolling in the program.
“These results are encouraging because we now have hard evidence that integrating the case management of behavioral health care and pharmacy with medical can have a positive impact on members’ overall health and help to manage the costs associated with chronic conditions,” said Hyong Un, MD, national medical director for Aetna Behavioral Health.
While the program led to a rise in pharmacy costs, Un noted that this increase was offset by an overall decrease in medical costs. “We believe these results are evidence that the program had a positive impact on adherence to medication for both behavioral health and co-morbid chronic medical conditions,” Un said.
